Direct Member Reimbursement (DMR) Form: Medications and Treatments

Reimbursement form (DMR) for grant recipients.

Direct Member Reimbursement Form: Medications and Treatments (pdf 171.05 KB)

Go to patient reimbursements page
Go to submitting claims overview page

  • Apply

    Get to know our grants and application process.

    Learn more

  • Advocate

    Get to know the ways PAN is advocating for healthcare access.

    Our work

  • Donate

    Help us support the millions who struggle to afford medications.

    Donate